Swimming Upstream

In our dedication to the underserved, has family medicine left the mainstream where we used to provide most of the care to most of the folks most of the time?

Family medicine has been swimming upstream for so long that we are leaving the mainstream behind. We are battling up tributaries, into the mountains and valleys. At the same time we are becoming an endangered species in the lakes and ocean where we used to populate the big waters, feed entire peoples and sustain healthy ecosystems.


“Family medicine has devoted so much of its energy to the needs of the underserved that we no longer meet the needs of the larger population.”

“… the Paradox of Primary Care Privilege: only the underprivileged have the privilege of having family doctors.”

“Everyone deserves to have a family doctor.”

“We need to establish caring relationships with people in power as well as with people in need.”

“If family practice doesn’t succeed in the cities, it won’t survive in the sticks.”

“… the irresistible power created by diversity, adversity, and unity.”

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Copyright © 2013 W.R. Phillips
Used with permission. Originally published in:
Phillips WR. Swimming Upstream. Washington Family Physician. 2012. 39(1):18-19.

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Learning by Write

Family physician writers were invited to explain, “Why I write.”

The practice of medicine is the management of meaning. The job of the physician—as master of diagnosis and therapy—engages us every day in observing and making sense out of what our patients show us and tell us. Our roles, as teacher, counselor, and coach, also call upon us to deliver information in ways that can help our patients understand what they need, change what they can, and cope with all the rest. We confront fear, manage uncertainty, and explain the unknown…. Read more.


“If illness is a narrative, then medicine is about listening and telling the stories we are privileged to hear.”

“Once written down, an idea can endure in spite of itself.”

“Practicing skills of observation changes our powers of perception.”

“Paying attention to the patient’s words and listening for their meaning is part of the power and the joy of medicine.”

“Maybe the clinical art of listening for heart murmurs has faded with the advent of echocardiography, but I am sure that no imaging technology will replace the art of hearing a patient’s pain.”

“Family physicians, particularly, have the privilege of hearing the whole story. If we listen closely, we can hear the stories that make us human.”

“As physicians, we have the privilege—sometimes the duty—to witness the suffering and courage around us.”

“Writing—like caring—is a signature skill of humanity.”

Read the essay.

See the other essays on “Why I write.”

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Copyright © 20013 Society of Teachers of Family Medicine. Originally published in: Phillips WR. Learning by write. Family Medicine 2013;45(1):48-49.

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If you can keep your head when one is crowning,
And be peaceful when all is going well;
If you can swim against the tide that’s drowning
So many people under profit’s swell;

If you can hear the fear among the nervous,
And tell a tear will trickle sometime soon;
If you can see yourself in lifelong service,
Yet save that special family afternoon;

If your wisdom can comfort many mothers;
If you hold the wrinkled hand, brand new or old;
And do so much to help so many others,
And keep the secrets you alone are told;

If you can tell that every life’s a story,
And listen close to hear the common strains;
If you can face the grim, the gross, the gory;
And often cure, but always ease the pain;

If you can deal with chaos and with humdrum,
Finding every day a new way you can grow;
If you know the community you come from,
Yet sometimes simply say just, “I don’t know”;

If you can fill the asystolic minute
With 10 cc’s of IV bicarb run;
Then walk out to the waiting room and in it
Share the failure of everything you’ve done;

If you can talk with calm and walk with power,
Treat common people with uncommon care;
If you see change as springtime’s future flower;
Yet keep the faith to which you’re honored heir;

If you can help with everybody’s illness,
And share the power knowledge can unlock;
If you can fill long silences with stillness,
Then you will know that you’re a Family Doc.

William R. Phillips, MD, MPH

See the original published poem.

Copyright © 2003 WR Phillips. Originally published in: Phillips WR. If. Family Practice Management. 2004 Jan;11(1):80.

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A Public Celebration of a Personal Doctor

Abstract – The life of a family doctor is engaged with the people, families, and community he or she serves. Caring changes lives. Yet, we seldom have the opportunity to hear the gratitude or to reflect upon the privilege. In this essay, two family doctors share the experience of seeing a community celebrate the life of their doctor. In these public reflections on their personal doctor, folks reveal how he saw their needs, understood their fears, and partnered with them to create futures. Their stories are compelling evidence that personal doctoring is alive and well and held deeply in the heart of America.

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“Transitions test our strengths, weaknesses, and values. For a family those times are often birth, marriage, illness, and death.”

“He’d look at you and know, but still
Would stop and listen anyway.
Everyone was important and everything
Held meaning. Patiently organizing the
Details, he caught the wonder and the mystery.”

“Dr. John had become part of the landscape, and the geography of the town just changed.”

“… a professional life full of challenges met and promises kept, of more successes than failures, more fulfillments than regrets.”

“…years of service, days (and some nights) of caring, and moments of tenderness.”

“… Personal doctors, living in the community and practicing among people they know, can base their medicine on evidence that is richer than randomized clinical trials.”

Read the essay

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Copyright © 2010 Annals of Family Medicine, Inc. Originally published in:
 Phillips WR, Green LA. A public celebration of a personal doctor. Annals of Family Medicine. 2010 Jul-Aug;8(4):362-5.

Republished in the anthology: Gotler RS, ed. The Wonder and the Mystery: 10 Years of Reflections from the Annals of Family Medicine. London, UK: Radcliffe Publishing; 2013. ISBN 9781846199820

Read about the book. How to order.

For more information on the anthology, see: Gotler RS. The Wonder and the Mystery: Your Voices, Your Stories. Ann Fam Med. 2013;11(3):205-206.

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